how long until Lexapro starts to work, likelihood Lexapro will work for your condition, and Lexapro vs. other Antidepressants
Two of the most important things to know when deciding on which med is the best for a particular condition1: how likely is it to work and how long will it take.
The odds of a med working for a particular condition and how long it generally takes to work should be fairly easy to nail down, and not need to be summed up by the Internet shorthand YMMV (Your Mileage May Vary). Aside from it being hard enough to get an accurate diagnosis when brain cooties are involved, why is it so difficult to figure out if Lexapro (escitalopram) is right for you and how long it will take for you to know that?
- Because no one is quite sure exactly what causes various conditions.
- Which is further complicated when everything is a spectrum disorder (e.g. bipolar 1, bipolar 2, all the others they still ignored in DSM-5).
- And they’re never really sure about how Lexapro works in the first place.
- Plus, if you have more than one condition for which you’re taking one or more medications to treat, things get really complicated.
- None of which is helped by studies that produce contradictory results and other quirks in The Literature.
Always remember: if your symptoms suddenly get a lot worse, call your doctor immediately. Any drug that makes your symptoms worse is a drug you probably need to stop taking as soon as possible.
We reference a shitload of studies here, so you might want to see our pages on how to deal if a study is legitimate and the tests and methodologies researchers use to measure the efficacy of medications, including during clinical trials to get FDA approval.
How Long Until Lexapro (escitalopram) Starts Working
Lexapro can start working within one week. As usual there are conflicting data. All the reports from people who’ve taken Lexapro that I’ve read (anecdotal evidence) indicate that Lexapro often starts working in the first week or two.
You should still give it at least three weeks, unless the side effects hit hard, fast, and don’t start getting better within two weeks of reducing the dosage (if there’s any room to reduce the dosage).
How Effective Lexapro (escitalopram) is for its Approved Uses
Major Depressive Disorder (MDD)
The odds are pretty good that Lexapro will work for MDD, as in you have a 60–75% chance that you’ll respond to Lexapro2 - i.e. it will do something positive - and a 60–70% chance of remission, i.e. your MDD symptoms will more-or-less go away and stay away, although you may have to keep taking your meds to ensure you stay symptom-free.
Keep in mind that:
- Serotonin reuptake inhibition, and everything else SSRIs do, is not the answer for everyone, either by itself or at all.
- When you pool all the data together (see below) you’ll find that Celexa and Lexapro are better than the other SSRIs. It’s marginally statistically significant for everyone who still takes the other SSRIs. Their real advantage comes from sucking less than the others and being better at preventing relapses, so if you and your doctor think you’re going to be depressed forever without meds, you’re way better off with Celexa or Lexapro than another SSRI or other antidepressant.
- We can’t hammer this point home as hard or often enough: antidepressants work only for people who are seriously depressed.3
Like most SSRIs the clinical trials published in the PI sheet used a ridiculously small set of people with vague results. How small? The usually don’t print the number of patients, that’s how small. Things are different in Canada, where some actual numbers are published in the PI sheet. But it tells us only that people felt somewhat better, and not how many of them did.
Unlike most antidepressants I was actually able to find the clinical trials on PubMed, although there are no more data in the abstracts than in the PI sheet. Except for Fixed-dose trial of the single isomer SSRI escitalopram in depressed outpatients. The discrepancies between the PI sheet and the abstract that are really telling. The US PI sheet, which doesn’t allow you to copy any text, has the typically vague result of “statistically significant greater mean improvement compared to placebo on the MADRS.” But when you look at the study:
Clinical response was evaluated by the Montgomery-Asberg Depression Rating Scale (MADRS), the 24-item Hamilton Rating Scale for Depression (HAM-D), the Clinical Global Impressions (CGI) scales, the Hamilton Rating Scale for Anxiety (HAM-A), and patient-rated quality-of-life scales.
RESULTS: Escitalopram, at both doses, produced significant improvement at study endpoint relative to placebo on all measures of depression; significant separation of escitalopram from placebo was observed within I[sic] week of double-blind treatment. Citalopram treatment also significantly improved depressive symptomatology compared with placebo; however, escitalopram, 10 mg/day, was at least as effective as citalopram, 40 mg/day, at endpoint. Anxiety symptoms and quality of life were also significantly improved by escitalopram compared with placebo. The incidence of discontinuations due to adverse events for the escitalopram 10 mg/day group was not different from the placebo group (4.2% vs. 2.5%; p = .50), and not different for the escitalopram 20 mg/day group and the citalopram 40 mg/day group (10.4% vs. 8.8%; p = .83). —Cipralex Canadian Product Monograph
Note how more scales are mentioned in the abstract. The PI sheet omits two points that numerous studies will repeatedly prove: while Lexapro usually doesn’t work any better than Celexa, it often does work faster than Celexa, or any other SSRI.
The Australian PI sheet confirmed that the clinical trial about preventing the relapse of depression symptoms I found before is indeed the one in the PI sheet. It, too, is pitifully small (181 taking Lexapro, 93 taking placebo), but at least it had everyone taking their pills for nine months. Close to 75% of the people taking Lexapro after 36 weeks were still not depressed, vs. 60% taking the wonder drug Placebo.
You’re probably a lot less likely to commit suicide when taking Lexapro than taking a placebo. But is that really a big surprise? I guess it is to some people.
There have been studies experimenting with dosages up to 50mg(!) a day. This is the first time I’ve read a Lundbeck-sponsored study of Lexapro where there has been a significant number of people quitting due to side effects (20%). 30mg could be a dosage to consider, especially if you know or suspect you’re a rapid or ultra-rapid metabolizer of drugs cleared by CYP2D6 (substrates), or you take a drug that induces CYP2D6, like Tegretol (carbamazepine). 40mg seems to be the upper limit of real efficacy.
Predicting if a med will work for you is something that can be really useful. What have we got for Lexapro…
- Is there a genetic test to predict if Celexa or Lexapro will work for you? Maybe. With only 40 people involved it’s too soon to tell. I’m sure the test is freaking expensive right now.
- Which is a better predictor: Omega-3 fatty acids (O3FA) or how neurotic you are? So if Woody Allen eats a lot of fish, would that mess up the study? The results: however much O3FA you have floating around won’t give you clue whether or not Lexapro may work for you, and while treating anxiety and depression at the same time is always difficult, following the usual Crazymeds titration schedule of low dosages with no target dosage allows Lexapro to work rather well for the combination.
Generalized Anxiety Disorder (GAD)
The story for anxiety disorders is a bit better. People in the Panic/Anxiety community love Lexapro. Like MDD efficacy rate is still around 70–75%, but as GAD (and many of the other anxiety disorders for which it’s used off-label) tends to respond at lower dosages than MDD, the side effects tend to suck a lot less than GAD and other treatments.
In regards to GAD, this double-blind study of 158 people taking Lexapro vs. 157 people taking placebo had 68% of the people taking Lexapro responding against 41% taking the placebo. Not too bad for the placebo. In Lexapro’s favor, though, on the Hamilton Rating Scale for Anxiety, those taking Lexapro averaged a 11.3 point drop from a score of 18 points or higher, whereas those taking the placebo dropped only an average of 7.4 points. So you can fool some of the people with GAD into feeling better, but even those you fool won’t feel better than they could have with a real med.
What looks like a follow up to the clinical trials for Lexapro’s approval for GAD has even better numbers than the above. Those who completed the 8-week double-blind trials were given the option of knowing they were taking Lexapro (escitalopram oxalate) 56% of the people made it to the end, so about half in all, or roughly 250 people were still helped by Lexapro (escitalopram oxalate) for generalized anxiety disorder (GAD), and helped a lot.
Just like with MDD, Lexapro helps to prevent the relapse of generalized anxiety disorder. At least when compared with placebo. After taking Lexapro for 8–12 weeks:
- In this study Only 19% of the people taking Lexapro had a relapse of symptoms compared with 56% of those who got the placebo.
- In this Lundbeck-funded study on generalized social anxiety disorder 22% of people taking Lexapro relapsed vs. 50% of those taking placebo. By their own admission Lexapro is just OK for social anxiety when compared with how it works for GAD or other meds.
- Lexapro is generally good for relapse prevention.
Likelihood Lexapro (escitalopram) will Work for Off-Label Applications
Panic-Anxiety Disorders other than GAD
Except for hoarding, where you’ll want Paxil, Lexapro may as well be approved for the rest of them. Oh, wait, Lexapro is approved to treat other anxiety disorders, just not in the US. We really need a way to streamline the approval process for meds when they’re already available here and approved for something else in practically every other country on the planet. In any event…
- OCD: You can tell that Lundbeck/Forest tried for approval in the US, because I could find placebo-controlled studies with only vague results. In this Lundbeck-sponsored clinical trial-looking study they used statistical methods I’ve never seen before. And the conclusion reached by this double-blind, placebo-controlled trial was “many patients with OCD responded to the Esciatolpram at the dosage of twenty milligram per day.” C’mon guys, could you try to be more vague? Fortunately papers like An emerging role for escitalopram in the treatment of obsessive-compulsive disorder, Escitalopram in the treatment of obsessive-compulsive disorder, and Escitalopram prevents relapse of obsessive-compulsive disorder, along with all the anecdotal evidence I’ve collected, tells us that, depending on the type of OCD you have, Lexapro has a 60–70% chance of working for you.
- SAnD: It’s more of a coin-toss here, as it’s a 50–60% chance. The odds are better with Paxil and Zoloft. Here’s another early clinical trial, and they get spanked here for their vague stats.
- Panic disorders (PD), with or without agoraphobia: Unlike OCD, these aren’t all over the map. Lexapro has a good 60–70% chance of working for you regardless of the type of PD you have.
- PTSD - unfortunately there just aren’t enough data for Lexapro and Celexa for either combat or non-combat PTSD to give you any odds. SSRIs are used to treat both combat and non-combat PTSD all the time, so you may as well try it.
Medicine Is The Best Medicine
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Lexapro (escitalopram) versus Other Antidepressants for its Approved Indications
Lexapro vs. Celexa
Lexapro vs. Celexa. This is one of the most asked questions we get when it comes to comparing meds, and it should be. Is there a real difference in efficacy between Lexapro and Celexa?
- Sort of, but not by much.
- Even though Lexapro works faster the real difference is in the long run, because Lexapro sucks a little less. So more people will take Lexapro for a longer time, but the difference is such that it matters only to individuals and national healthcare systems, and not HMOs and insurance companies. Which is why generic citalopram is covered while still-expensive escitalopram isn’t.
- Is it worth switching from Celexa to Lexapro? If you’re thinking about it then it’s worth talking to your doctor about it, but it’s probably not worth arguing with either whoever prescribes it or pays for it.
- But if you haven’t started on either, and Lexapro is an option that won’t cost much more than Celexa, go for the Lexapro.
- Let’s see what the science says:
- Cipralex vs. Cipramil in outpatients with depression. A Lundbeck-sponsored trial. 20mg of Cipralex/Lexapro vs. 40mg of Cipramil/Celexa. The results: Lexapro worked better (76% response rate, 61% remission rate vs. 56% and 43% for Celexa), and while both didn’t suck all that much, Lexapro sucked even less (4 out of 138 quit taking Lexapro due to side effects vs. 9 out of 142 for Celexa).
- Cipralex vs. Cipramil for depression treated by primary care physicians. Another Lundbeck-sponsored trial. 10mg of Cipralex/Lexapro vs. 20mg of Cipramil/Celexa. The results: A little odd. At the end of 8 weeks Lexapro had a 63% response rate and 55% remission rate vs. Celexa’s 55% and 45%, by week 24 Lexapro had an 80% response rate and 76% remission rate vs. Celexa’s 78% and 71%. The odd part is both meds were way more effective for the moderately depressed than the severely depressed at week 8, and Lexapro was barely more effective for the moderately depressed at week 24. This runs counter to all the studies showing meds to be more effective for the severely depressed. But there are always studies with atypical results.
- Lexapro vs. Celexa vs. Effexor for efficacy and cost of treating depression. Britain’s NHS undertook this study. The results: Lexapro “dominates” Celexa and Effexor. That’s what they wrote. Lexapro “just dominates” Effexor.
- Lexapro vs. Celexa vs. Effexor for efficacy and cost of treating depression. Just like the above study, only in Spain. They also use the term “dominant.” Otherwise Lexapro had a higher remission rate than Celexa and Effexor (58% vs. 38% vs. 32%), otherwise there wasn’t much difference between Lexapro and Celexa. Both were better than Effexor.
- escitalopram vs. citalopram vs. sertraline for Unipolar Major Depression. 10–20mg of Lexapro vs. 20–40mg of Celexa vs. 50–150mg of Zoloft. The results: holy shit! 97% response rate for Zoloft vs. 90% for Lexapro vs. 86% for Celexa!?! Oh, wait, the trial was sponsored by Torrent pharmaceuticals. The real winners were the researchers. I’m taking this one with a shaker of salt.
- Lexapro vs. Celexa - which is worse to overdose on? This is actually an interesting question, as only critters have been given more than 60mg of Lexapro. Does the two-to-one dosage ratio of Celexa to Lexapro hold up when you take an entire bottle? How much difference does the r-enantiomer of Celexa make? The results: Celexa is more toxic than Lexapro, but, like all SSRIs, it’s next to impossible to kill yourself with them. Although the median dosage of Celexa was higher (310mg vs. 130mg for Lexapro. The equivalent dosage of Celexa would be 260mg.), it’s hard to tell by how much that skewed the results. The most striking was the incidence of seizures, 30 for Celexa vs. 1 for Lexapro.
- Is escitalopram really relevantly superior to citalopram in treatment of major depressive disorder? A meta-analysis of head-to-head randomized trials. This analysis of Lundbeck’s clinical trials, and some of the studies and trials listed above, calls statistical shenanigans. Their main concerns: Over-reliance on the bullshit MADRS - see the page on psych tests for more info - and disputing claims of statistical significance. I’ll leave the latter up to people with better stat chops than I have. As this is the full text and the full text is available for several of the referenced papers, you can compare them all yourself.
- Escitalopram: superior to citalopram or a chiral chimera? This analysis also calls statistical bullshit on Lundbeck’s claims that Lexapro is superior to Celexa.
- This analysis looked at the same data and thought it all looked good.
Lexapro vs. Other Meds for Major Depression (MDD)
- Efficacy of escitalopram in the treatment of major depressive disorder compared with conventional selective serotonin reuptake inhibitors and venlafaxine XR: a meta-analysis. The results of this Lundbeck-sponsored cage match: Lexapro beat them all, hands down. Surprise, surprise.
- Escitalopram versus other antidepressive agents for depression. Works better than Prozac and Celexa, sucks less than Cymbalta.
- Lexapro vs. nortriptyline for various aspects of depression. It’s kind of hard to tell if Lundbeck and GSK had any real influence on this study. In any event the results were: it depends on what is making you depressed. If you need to feel better about yourself, stop having to drag yourself out of bed and from one place to another, and need to know things will get better, then Lexapro is the better drug. If you need to sleep at night, eat, and want to have sex again, then nortriptyline is the better drug. Hmm, there may be something to the hypothesis floating around that men respond better to TCAs and women to SSRIs.
- Zoloft vs. Lexapro vs. Effexor vs. the brain-derived neurotrophic factor (BDNF) hypothesis of depression. A recent hypothesis of what causes depression and how meds fix it involves how much BDNF we have floating around and the effect meds have on it. The results: while all the depressed people in this study had lower amounts of BDNF than the
professional guinea pigshealthy control subjects, the meds acted very differently. Zoloft increased it after five weeks, Effexor took somewhere around six months to change it, and Lexapro didn’t affect it at all. Yet all three were about equally effective in treating depression. So much for that idea.
- Zoloft vs. Lexapro - which costs less to treat depression? The HMO bean-counters have decided that over six months it costs $919 dollars to treat someone with Lexapro and $1351 to treat them with Zoloft.
Lexapro for GAD
- Paxil vs. Lexapro vs. placebo for generalized anxiety disorder. Five, 10 & 20mg of Lexapro were compared with 20mg of Paxil and a placebo. The winner: 10mg a day of Lexapro. As two of the authors work for Lundbeck, who also sponsored the study and manufacture Lexapro, that’s not a particularly surprising result.
Medicine Is The Best Medicine
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How Lexapro (escitalopram) Compares with Other Drugs for Off-Label Treatments
- Lexapro vs. Paxil for Social Anxiety Disorder (SAnD). This Lundbeck-sponsored study isn’t very fair, as it compares 20mg of the older, immediate-release Paxil against 5mg, 10mg, and 20mg of Lexapro. While 20mg of immediate-release Paxil is GSK’s recommendation for SAnD, it’s 25–37.5mg a day for the controlled-release flavor. While 10mg of Lexapro is equal to 10mg of Paxil, 20mg of Lexapro is more like 37.5mg of Paxil CR. So it’s not all that surprising that 20mg of Lexapro was more effective than 20mg of Paxil.
- Lexapro vs. Celexa vs. Placebo for Panic disorders. Panic disorders are off-label for Celexa as well. The results - Lexapro and Celexa are both really good for panic, and Lexapro sucks less than the placebo. This sort of thing shows up in a lot of Lexapro studies and clinical trials: “The rate of discontinuation for adverse events was 6.3% for escitalopram, 8.4% for citalopram, and 7.6% for placebo.”
- Lexapro vs. Celexa vs. Placebo for Panic disorders - the sequel. The results - Lexapro kicked Celexa’s ass, which is something you don’t see very often. This was done by DJ Stein, who is one of Lundbeck’s favorite researchers, so he could have set it up to slant things in Lexapro’s favor. The abstract isn’t very forthcoming in results:
Treatment with escitalopram was associated with significant improvement on all 5 subscales of the P&A. Citalopram was significantly different from placebo in 3 subscales. […] Escitalopram was superior to placebo on 12 of 16 items of the Q-LES-Q, while citalopram was superior on 7 items.”
Unlike Dr. Stahl’s study above, there’s no hint in the abstract as to what “significant” means.
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1 Assuming you were correctly diagnosed in the first place.
2 The data are often contradictory when compared with Celexa. Celexa averages 60-70% for both response and remission, while Lexapro is often in the neighborhood of 70-75%; hence the big spread on the response rate that seems a bit low given the results of a lot of studies, trials, and anecdotal evidence.
3 Most of the time at any rate. There's always an outlier study or two, as you'll see if you keep reading this page.
If you have any questions not answered here, please see the Crazymeds Lexapro discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher crazymeds.us
|Last modified on Friday, 30 May, 2014 at 13:38:17 by JerodPoore||Page Author JerodPoore||Date created|
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Almost all of the material on this site is by Jerod Poore and is copyright © 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, and 2014 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained through our personal experience and the experiences family, friends, what people have reported on various reputable sites all over teh intergoogles, the medications’ product information / summary of product characteristic (PI/SPC) sheets, and from sources that are referenced throughout the site. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
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‘Everything is true, nothing is permitted.’ - Jerod Poore
1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas? I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.